Entire Oral Cavity Research Articles

New Device for Collecting Intra-oral Findings of Unknown Body

In dental identification, the collection of intra-oral images is extremely important. We propose the Dental Watch(®) as a new device for collecting intra-oral findings in situations where sufficient jaw-opening or adequate lighting cannot be obtained in such cases of dead bodies within a day after death or burned bodies encountered in mass disaster. This device is an improved home video camera for taking intra-oral images. It is lightweight and cordless, allowing it to be operated with one hand, and an audio function allows comments to be made and recorded on obtaining findings at the same time as images are taken. In addition, this device allows images of the entire oral cavity to be taken comparatively easily, even when only a minimal degree of jaw movement is available. This device is extremely useful in situations where a single dentist inspector must obtain findings and make an accurate and detailed Dental Chart.

A Giant Hemangioma of the Tongue

Introduction: Vascular abnormalities are relatively uncommon lesions, but head and neck is a common region for vascular malformation which is classified as benign tumors. In this paper, the authors report a rare presentation of vascular malformation in the tongue and its managements. Case Report: An 18 months 2 old child presented with a giant mass of tongue which caused functional and aesthetic problem. The rapid growth pattern of cavernous hemangioma was refractory to corticosteroid. The lesion was excised without any complication. Since the mass was so huge that not only filled entire oral cavity but was protruding outside, airway management was a great challenge for anesthesia plan and at the same time surgical technique was difficult to select. Conclusion: Despite different recommended modalities in managing hemangiomas of the tongue, in cases of huge malformations, surgery could be the mainstay treatment and provided that critical care measures are taken in to account, could be performed very safely.

Improvement in Quality of Life of An Oncological Patient by Laser Phototherapy

Common side effects of radiotherapy (RT) to the head and neck include oral mucositis, xerostomia, and severe pain. The aim of this study is to report improvement in the quality of life of an oncological patient by laser phototherapy (LPT). The patient, a 15-year-old girl diagnosed with mucoepidermoid carcinoma, underwent surgical excision of a tumor of the left palatomaxilla. After that, she was subjected to 35 sessions of RT (2 Gy/d). Clinical examination revealed the spread of severe ulcerations to the jugal mucosa, gums, lips, hard palate, and tongue (WHO mucositis score 3). She had difficulty in moving her tongue and she was unable to eat any solid food. Oral hygiene orientation and LPT were performed throughout all RT sessions. A continuous diode laser, 660 nm, 40 mW, 6 J/cm(2), 0.24 J per point in contact mode, with spot size of 0.04 cm(2) was used in the entire oral cavity. A high-power diode laser at 1 W, 10 sec per cm of mucositis, approximately 10 J/cm(2), was used in defocused mode only on ulcerative lesions. After the first laser irradiation session, decreases in pain and xerostomia were reported; however, a more significant improvement was seen after five sessions. At that point although the mucositis score was still 2, the patient reported that she was free of pain, and consequently a palatine plate could be made to rehabilitate the entire surgical area. Seventeen laser irradiation sessions were necessary to eliminate all oral mucositis lesions. Normal oral function and consequent improvements in the quality of life of this oncologic patient were observed with LPT.

Multiple Primary Oral Cancers

This study reports 5 patients with multiple primary oral cancers. The tumours were synchronous in 3 patients and metachronous in 2. Histopathologically, 11 squamous cell carcinomas were recognised in these 5 patients, and 5 of these were early cancers with superficial invasion. Precancerous lesions or conditions were possibly associated with multiple primary oral cancers in 4 patients (1 male and 3 females). Although management with chemotherapy, radiotherapy, and/or surgery was employed, 2 of the 5 patients died of oral cancer. This study emphasises that careful examination of the entire oral cavity and rigid follow-up are essential for a successful outcome.

Distant metastases of a squamous cell carcinoma of the tongue in peripheral skeletal muscles and adjacent soft tissues

A 66-year-old female patient was admitted to our department with a large tumor of the tongue measuring 10 cm in diameter. The tumor occupied nearly the entire oral cavity and showed exophytic and ulcerative areas. Histological analysis revealed a low grade squamous cell carcinoma (SCC) of the tongue. Bilateral enlarged cervical lymphatic masses were also present. The extent of the tumor infiltration was assessed by fluoro-2-deoxy-glucose-positron emission tomography (PET) scans showing an elevated activity of the tracer corresponding to the assumed cervical metastases. Additionally, pulmonary metastases were identified. Contrast enhanced computed tomography (CT) scans showed metastases in the soft tissues of the abdomen, legs and arms. Foci of distant metastases were found in the left upper anterior thoracal wall, near the intraabdominal portion of the aorta, near the right iliac crest and in both the right vastus medialis- and adductor magnus muscles. The final diagnosis was a T4N3M1(G3)(C3) SCC of the tongue with multiple distant thoracal, abdominal and intramuscular metastases. The survival expectancy was five weeks, and the patient finally deceased by cardiopulmonary complications.

Stomatodynies primaire et secondaire : un diagnostic difficile

Primary stomatodynia involves mainly women after menopause presenting somatization, depression and anxiety at values higher than control subjects. This chronic pain is often an intense burning pain beginning in the tongue the entire oral cavity, increasing in intensity through the day with a high level of emotional after effects. These patients often describe two associated symptoms: mouth dryness sensation and altered taste. The causes remain uncertain. The participation of female sexual hormones and neuropathic factors has been suggested possibly through a sensory neuropathy of small fibers of the oral mucosa. Normal clinical examinations and non clinical tests differentiate primary from secondary stomatodynia. The management consists in using low doses of topical clonazepam without swallowing or systemic clonazepam. The association of this drug with tricyclic antidepressants has given variable results. A cognitive behavioural management has been successfully attempted.

Mechanical disruption of seagrass in the digestive tract of the dugong

AbstractThe cheek teeth in dugongs are considered to be largely non‐functional whereas the oral horny pads are important both in mechanical disruption of the diet and in conveying seagrass through the mouth. Particle size distributions of digesta from 41 dead stranded dugongs were examined to investigate the relationship between degree of food breakdown, gut region and functional surface area of the mouthparts. The in vitro ease of fracture of major dietary seagrass species were compared. The rate of food breakdown through the gut appears to be more closely linked to fibre level of the diet than to size or age of the dugong and its mouthparts. Low fibre seagrass, for example Halophila ovalis, breaks down at a faster rate than high fibre seagrass, for example Zostera capricorni both in dugong guts and in vitro. Several structural characteristics of seagrass, including level and arrangement of fibre, and water content, make it particularly amenable to mechanical breakdown. The soft mouthparts of the dugong are highly modified so that the entire oral cavity functions to crush low fibre seagrasses. Thus, the dugong has developed an efficient method of food ingestion and mastication that is suited to processing large quantities of soft seagrass during short dive times. The potential cost to the dugong in having lost its hard dental surfaces is that it has become restricted to a low fibre diet.

White sponge naevus with minimal clinical and histological changes: report of three cases

White sponge naevus (WSN) is a rare autosomal dominant disorder that predominantly affects non-cornified stratified squamous epithelia: oral mucosa, oesophagus, anogenital area. It has been shown to be related to keratin defects, because of mutations in the genes encoding mucosal-specific keratins K4 and K13. We illustrate three cases diagnosed as WSN, following the clinical and histological criteria, with unusual appearance. They presented with minimal clinical and histological changes that could be misleading in the diagnosis. The patients showed diffuse irregular plaques with a range of presentations from white to rose coloured mucosae involving the entire oral cavity. In one case the lesion was also present in the vaginal area. The histological findings included epithelial thickening, parakeratosis and extensive vacuolization of the suprabasal keratinocytes, confirming WSN diagnosis. Clinical presentation and histopathology of WSN are discussed in relation to the differential diagnosis of other oral leukokeratoses.

Peppermint Oil Chemical Burn

A 49-year-old woman presented to the emergency room with difficulty in breathing, drooling, and fever. Twelve hours before her admission she had ingested 40 drops of pure nonheated peppermint oil (Mentha piperita– 100% pure etheric oil). The patient had used this product many times in the past while suffering from a common cold, each time ingesting 1 or 2 drops. Following these repeated administrations the patient had never had from any form of an allergic reaction. On physical examination, the patient had tachypnea of 24 breaths per minute, inspiratory stidor, excess salivation, tachycardia of 132 beats per minute, fever of 39°C, multiple burns in the entire oral cavity and pharynx, edema of the upper and lower lips, and edema of the tongue, uvula, and soft palate (Fig 1. Laryngoscopy revealed a cherry-red and swollen epiglottis, hypo-pharyngeal and laryngeal mucosal burns, and pooling of saliva in both pyriform sinuses (Fig 2). The patient was transferred to the operating room where a trans-nasal awake intubation was performed. She was treated with intravenous steroids and antibiotics and underwent successful extubation 24 hours later. The edema and the burn signs resolved gradually over the next 2 weeks.

Polymorphism of the MICA gene and risk for oral submucous fibrosis.

Oral submucous fibrosis (OSF), an insidious, pre-cancerous, chronic disease that may affect the entire oral cavity and sometimes extend to the pharynx has been reported to be associated with immune function. The major histocompatibility complex (MHC) class I chain-related gene A (MICA) is expressed by keratinocytes and other epithelial cells, and its encoded protein interacts with gamma/delta T-cells localized in the submucosa. The MICA gene has a triplet repeat (GCT) polymorphism in the transmembrane domain resulting in five distinct allelic patterns. We analyzed MICA polymorphism in 80 OSF patients and 351 randomly selected unrelated controls by using the ABI Prism 377-18 DNA sequencer (Applied Biosystems) to analyze the sample DNA PCR products. The number of microsatellite repeats was estimated with Genescan 672 software (Applied Biosystems) with a standard size marker of GS-350 TAMRA. The phenotype frequency of allele A6 of MICA in subjects with OSF was significantly higher than that in controls (OR = 3.48; 95% CI = 1.8-6.71; P = 0.0002), as was the frequency of the allele (OR = 2.65; 95% CI = 1.44-4.86; P = 0.001). The results suggest that allele A6 in MICA might confer a risk for OSF.

Prophylactic Treatment of Mycotic Mucositis in Radiotherapy of Patients with Head and Neck Cancers

Patients undergoing radiotherapy for head and neck cancer are at increased risk of developing oral candidiasis. The objective of this study was to investigate the clinical Candida mucositis and interruptions in radiotherapy in patients suffering from head and neck cancer, receiving fluconazole in comparison with a control group without specific prophylaxis. Eighty consecutive patients were randomized in a prospective double-blind trial of prophylactic oral fluconazole or treatment with the same drug when mycotic infections appeared. Adult head and neck cancer patients who were undergoing treatment with radiotherapy and/or chemotherapy, radiotherapeutic coverage of the entire oropharynx and oral cavity at least 3 cm anterior to the retromolar trigone and receiving a total dose of more than 6000 cGy and Karnofsky Performance Status (KPS) >70 were included in the study. Group A received radiation therapy plus fluconazole (Fluzole 100 mg/day) starting from the sixth irradiation session throughout the treatment; 40 patients in group B received the same baseline treatment, but were given fluconazole only when mycotic infections appeared. We evaluated 37 patients in group A and the first 37 patients were evaluated in group B. Three of the patients in group A (8.1%) and 14 of the patients in group B (37.8%) demonstrated clinical candidasis. Radiotherapy was interrupted in all of these patients. The differences between the two groups were statistically significant with respect to clinical candidiasis (P = 0.005). The median discontinuation time was 5 days (range, 3-7 days) in group A and 7 days (range, 4-10 days) in group B. The median dose resulting in clinical candidiasis was 3200 cGy (range, 2200-5800 cGy) in all groups. In the fluconazole group it was 4200 cGy and in the control group 2800 cGy. These results suggest that patients undergoing head and neck radiation therapy are at risk of developing candidiasis and that fluconazole may be used to reduce the frequency of mycotic infections and to improve the radiotherapy schedule in head and neck cancer patients.

Tongue coating and salivary bacterial counts in healthy/gingivitis subjects and periodontitis patients.

The papillary structure of the dorsum of the tongue forms a unique ecological site that provides a large surface area favoring the accumulation of oral debris and microorganisms. These micro-organisms of the tongue may be of influence on the flora of the entire oral cavity. The normal appearance of the dorsum of the tongue is either pinkish or has a thin white coating. For the present study a scoring method was developed to describe the appearance of the dorsum of the tongue in relation to the extent of color and thickness of tongue coating. The purpose of this study was to investigate the discoloration and coating of the tongue in healthy/gingivitis subjects and periodontitis patients. Furthermore, to determine the relationship between the appearance of the tongue and the bacterial load in salivary samples. 2 groups of patients were studied, 70 healthy/gingivitis subjects and 56 periodontitis patients. After scoring of the tongue a salivary sample of each patient was taken and analyzed using a phase-contrast microscope. This investigation showed that most discoloration was found on the distal part of the tongue. The mean number of bacteria per ml sample in relation to a pink, white and yellow appearance of the tongue was 948, 855 and 900 (x 10(6)) respectively. The mean number of bacteria per ml sample in relation to no, thin and thick coating was 948, 863, and 895 (x 10(6)), respectively. Analysis did not reveal a relationship between discoloration, coating thickness and total bacterial load. The mean number of bacteria per ml in healthy/gingivitis subjects was 860 and in periodontitis patients 918 (x 10(6)). No relationship between the appearance of the tongue and salivary bacterial load could be detected. There was no difference in bacterial load between the healthy/gingivitis and the periodontitis group within the present study population.

Skin Signs in Anorexia nervosa

Background: Eating disorders are becoming an epidemic in Europe, particularly among young women, but European studies concerning this topic are few. In eating disorders, significant medical complications occur in all of the primary human organ systems, including the skin. Objective: The purpose of this study was to improve the knowledge of skin signs in anorexia nervosa (AN) and verify whether cutaneous differences exist between the restrictive type and the bulimic type. Methods: A noncontrolled clinical study was performed in 24 consecutive patients with the restrictive and the bulimic types of AN in order to verify whether the cutaneous signs are different in the two types. The dermatological examination included the entire skin, oral cavity, hair and nails, with attention to skin pathologies prior to the development of AN. Results: In all the patients, the most frequent skin manifestations were xerosis (58.3%), hair effluvium (50%), nail changes (45.8%), cheilitis (41.6%), acne (41.6%), gingivitis (33.3%), acrocyanosis (29%), diffuse hypertrichosis (25%), carotenoderma (20.8%), generalized pruritus (16.6%), hyperpigmentation (12.5%), striae distensae (12.5%), factitial dermatitis, seborrheic dermatitis (8.3%), poor wound healing, melasma and Russell’s sign (4.1%). In the patients with the bulimic type of AN, hair effluvium, acne, gingivitis, nail changes and generalized pruritus were more frequent than in the patients with the restrictive type. Russell’s sign and seborrheic dermatitis were exclusively detected in the bulimic type. Hyperpigmentation, striae distensae, factitial dermatitis, poor wound healing and melasma were exclusively observed in the restrictive type. Cheilitis, diffuse hypertrichosis and carotenoderma were more represented in the restrictive type. Two patients with restrictive type of AN were followed up for a period of 3 years. In both, xerosis, cheilitis, acrocyanosis, hyperpigmentation and acne improved in relation to the increase in BMI. Hair effluvium and diffuse hypertrichosis appeared not to be linked to this parameter. Conclusion: Skin changes are prevalent among patients with AN. Some changes seem to depend on the type of AN or to be linked to the BMI.

Organization of orosensory responses in the nucleus of the solitary tract of rat.

1. The receptive field and topographic organization of single orosensory neurons located throughout the rostral division of the nucleus of the solitary tract (rNST) was studied by determining their responsiveness to gustatory stimulation of the entire oral cavity and to gustatory and mechanical stimulation of restricted oral regions. The rNST contained roughly equal numbers of two distinct populations of orosensory neurons, one responsive exclusively to oral mechanical stimulation (M neurons), the other to gustatory stimulation (G neurons). Some G neurons also responded to oral somatosensory stimuli, but usually less vigorously than to gustatory stimuli. The distribution of these two populations of rNST neurons was topographically organized: G neurons were centered anteriorly and medially to M neurons. 2. Eight of 44 G neurons responded only when the whole oral cavity was stimulated, but the remaining 36 cells responded to circumscribed stimulation of taste buds on the anterior tongue (AT), foliate papillae of the posterior tongue, nasoincisor ducts, retromolar mucosa (RM), or soft palate (SP). Overall, AT and SP stimulation were the most effective, and RM stimulation the least effective, for activating nucleus of the solitary tract (NST) G neurons. 3. Approximately half of the G neurons for which a receptive field could be defined (N = 36) responded to stimulation of a single taste receptor subpopulation, but the remaining neurons received convergent input from two or more taste bud groups. The receptive field configurations for convergent G neurons were orderly: convergence occurred preferentially between receptor subpopulations either within the anterior oral cavity (AO) or the posterior oral cavity (PO). An AO-PO distinction also was reflected in the topographic organization of gustatory responses. The mean location of neurons responding optimally to AO gustatory stimulation was more anterior in the NST, and also tended to be more lateral and ventral than the location of neurons that responded optimally to PO stimulation. 4. Forty-four rNST M neurons responded to innocuous mechanical stimulation of restricted areas of the tongue, palate, buccal mucosa, or periodontium. Stimulation of the hard palate and circumvallate papilla were most effective, whereas periodontal stimulation was least effective for activating these cells. 5. A majority (32 of 44) of rNST M neurons responded to stimulation of more than one of the oral sites tested.(ABSTRACT TRUNCATED AT 400 WORDS)

Changes in properties of neuronal responses in two cortical taste areas in rats of various ages

Changes in the features of responses of cortical taste neurons were studied in granular insular (GI) and dysgranular insular (DI) areas of urethane-anesthetized SD rats of four age groups (4–10, 14–20, 25–35 and > 90 days). Stimuli included four basic taste stimuli, 0.1 M NH 4Cl, and the water extract of a food pellet, applied to the entire oral cavity. At the age of 4–10 days, taste neurons showed no spontaneous discharge, and most responded to NH 4Cl in a phasic fashion. In older age groups, however, there was a spontaneous discharge, and tonic taste responses were evident; some responded better to the four basic stimuli and to the food than to NH 4Cl. With only a few days' difference in age, inhibitory responses were also noted in both areas. Average taste responses increased or decreased at different ages, depending on the type of taste stimulus and recording area. When taste responses were plotted against the four basic taste stimuli in the order of sucrose, NaCl, HCl and quinine along the abscissa, some neurons showed double-peaked response profiles. This suggests the convergence and mutual inhibition of afferents at single cortical neurons. The fraction of neurons with double-peaked response profiles increased at the age of 25–35 days in both areas. Neurons in rats aged 25–35 days were predominantly sensitive to either NH 4Cl or NaCl, or to either food or sucrose. Neurons in rats of other ages, during the preweanling and the adult stages, tended to respond to both these stimuli. Our observations suggest that cortical taste neurons develop in the rat brain in accordance with the maturation of both the taste receptors and the neural networks.

顔貌写真撮影法の考案―3面顔貌規格同時撮影法―

Together with a diversification of the clinical dental needs of patients, there has been a tendency for simultaneous increases in the extent of the clinician's responsibilities in terms of both quality and quantity. In the field of clinical photography, for cases that had been handled with simple intraoral photographs in normal treatment, recently pictures are often taken of the face and lips including the teeth. In particular there has been a gradual increase in the need for facial photographs, and there has been a continual increase in the demand for pictures that provide a greater amount of information than has been acquired with conventional methods.The actual clinical treatment of gnathology, which includes responsibility for the entire oral cavity, must be carried out by dealing with the acquisition of a variety of information associated with the patient's face. Consequently, acquisition of objective data requires high quality facial photographic methods. I will introduce a facial photographic method I devised that can simultaneously photograph the frontal, angular and lateral face of patients.

Taste area in granular and dysgranular insular cortices in the rat identified by stimulation of the entire oral cavity

While applying natural stimulation to the entire oral cavity, we recorded responses from 489 neurons (400 mechanoreceptive, 84 taste and 5 cold neurons) in the insular cortex of urethane-anesthetized rats. Intermingled with the mechanoreceptive neurons was a major group of taste neurons located in the granular or dysgranular insular area at levels of 2.55-1.20 mm anterior to the bed nucleus of the anterior commissure as stereotaxically located. Most of the taste neurons were also sensitive to mechanical stimulation of the oral and/or perioral tissue.

Thermal sensitivity of neurons in a rostral part of the rat solitary tract nucleus

While stimulating the entire oral cavity of anesthetized rats, we recorded 3 types of neurons in the solitary tract nucleus; taste, mechanoreceptive and cold neurons. Most of the taste neurons were sensitive to thermal as well as to mechanical stimulations. Taste neurons predominantly sensitive to sucrose responded to warning and those most excited by NaCl or HCl were sensitive to cooling, and significant correlations were found between sucrose and warming and between NaCl and cooling. Most of the cold-sensitive taste neurons had receptive fields (RFs) at the anterior tongue and warm-sensitive taste neurons had whole or part of the RFs at the nasoincisor duct. About half the number of mechanoreceptive neurons were sensitive to cooling, producing phasic responses. RFs of some thermosensitive mechanoreceptive neurons and cold neurons were located. Warm-sensitive mechanoreceptive neurons or warm neurons were not evident. Therefore, interaction between thermal and taste sensations in the oral cavity probably takes place in the solitary tract nucleus, as well as in the chorda tympani.

Convergence onto hamster medullary taste neurons

Research has shown that gustatory afferents innervating different areas of the oral cavity converge onto single neurons in the nucleus tractus solitarii (NTS). However, most studies of gustatory physiology have only stimulated the receptors on the anterior tongue. No information exists on the response of hamster NTS neurons to stimulation of receptors located in other areas of the oral cavity. The present investigation compared responses of hamster NTS neurons to stimulation of receptors on the anterior tongue and posterior oral cavity, and to stimulation of both receptor populations together. Of the neurons, 64% responded to both anterior tongue and posterior oral cavity stimulation. The remaining neurons responded exclusivel to stimulation of one area. Cells responsive to both fields of stimulation were found throughout the rostral NTS. Cells responding to stimulation of only one field were anatomiically separate. Most neurons (69%) were more responsive to anterior tongue than posterior oral cavity stimulation. The neural responses to stimulation of both fields simultaneously were complex. Frequently, a cell's response was intermediate between those produced by stimulation of either receptor population alone. In other cases the response was the same as the larger of the two individual responses. The breadth of responsiveness to the 4 basic taste stimuli (sucrose, NaCl, HCl and quinine-HCl) was similar for both receptor populations, but the breadth of tuning of an individual cell for one field of stimulation was not correlated with its breadth of responsiveness for the other. In contrast, the breadth of tuning following stimulation of the entire oral cavity was correlated with that following stimulation of the anterior tongue.

Topographic and laminar organization of the vagal gustatory system in the goldfish, Carassius auratus.

The large majority of intraoral taste buds in goldfish are located on the gill arches and on the palatal organ, a muscular organ situated on the roof of the mouth. These taste buds are innervated by branches of the vagus nerve which terminate in a laminated vagal lobe, itself being an enlargement of the special visceral sensory column of the medulla. The tracer horseradish peroxidase (HRP) was used to determine the connectivity of the various branches of the vagus nerve that innervate the oropharyngeal gustatory surfaces. The entire oral cavity is mapped onto the vagal lobe so that the anterior end of the palatal organ and the most anterior gill arch are represented anteriorly in the vagal lobe; progressively more posterior oral structures are represented progressively more posteriorly in the lobe. The medial part of the palatal organ and the opposing gill arch surface, i.e., the ventromedial portion, are represented ventrally in the vagal lobe. The dorsolateral portions of the palatal organ and gill arches are represented dorsomedially in the vagal lobe. The topographic representation of the oral structures is similar for both the motor and sensory systems. In addition to this overall topographic organization, the different oropharyngeal structures are represented differentially in the layers of the vagal lobe. Palatal organ inputs reach layers VI and IX while gill arch inputs terminate in layers II, IV, and IX. The overall organization of the vagal lobe suggests a highly organized reflex system which is involved in the separation of food from substrate, especially during bottom feeding.